Barbed sutures have broad surgical applications, such as tissue approximation/plication, wound closure, and fixation of prosthetic devices to tissue. In vivo wound security, tissue compatibility, and scar cosmesis after wound repair are of particular interest to surgeons using barbed sutures.
For unidirectional barbed sutures having barbs facing in only a single direction, an anchor or knot is often used at the end to stop suture movement in the direction opposite to that in which the barbs face. Bi-directional barbed sutures typically have barbs facing in a first direction 101 on a first side of the suture, and barbs facing in the opposite direction 102 on a second side of the suture as shown in FIG. 1. Although these sutures resist movement in both directions, their insertion either requires some type of sheath or insertion device through which the suture is drawn (and which is later removed), or a double armed suture allowing the first end of the suture to be drawn through tissue with a first suture needle and the second end of the suture to be drawn through tissue with a second suture needle.
Double armed sutures, however, limit the wound closure or tissue approximation patterns that can be used. For example, the surgeon typically needs to begin suturing from the middle of the closure line out in two different directions. This technique may not always be acceptable to keep the appropriate tissue apposition.
When a sheath or tubular insertion tool is used, use of the suture is typically limited to procedures requiring short and in particular, straight placement. It is difficult for a surgeon to make several running stitches with a sheathed barbed suture due to the high frictional forces that accumulate along a torturous path. Further, when a surgeon tries to remove the sheath, the barbs as well as the surrounding tissue will likely be damaged.
Accordingly, there remains a need for a bi-directional barbed suture that can more readily and easily be inserted.